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Normal Vaginal Births Cause Infant Brain Hemorrhages
CHAPEL HILL, N.C., Jan. 30 -- Intracranial bleeding in newborns has been found common after a vaginal birth, although the bleeding is limited and apparently has no effect, according to researchers here. Action Points
Explain to expectant parents that this study has found small intracranial hemorrhages in about one in four infants delivered vaginally, compared with none among babies delivered by Caesarian section.
Point out that the bleeding was limited and had no apparent short-term clinical effects.
Caution that more research is needed and note that the vast majority of people delivered vaginally appear to have no later difficulties.
In a study using magnetic resonance imaging, about one infant in four delivered vaginally had at least one form of intracranial hemorrhage, found John Gilmore, M.D., of the University of North Carolina School of Medicine, and colleagues.
MRI did not show signs of bleeding for babies born by caesarian delivery, they reported in the February issue of Radiology.
"Small bleeds in and around the brain are very common in infants who are born vaginally," Dr. Gilmore said. "It seems that a normal vaginal birth can cause these small bleeds."
But he added that although more research is needed on the implications of the hemorrhages, vaginal birth has not suddenly become unduly risky.
"Obviously, the vast majority of us who were born vaginally and may have had these types of bleeds are doing just fine," he said. "Humans have been born vaginally for a very long time, and our brains probably evolved to handle vaginal birth without major difficulty."
Intracranial hemorrhage in full-term infants is usually associated with symptoms such as apnea, bradycardia and seizures, Dr. Gilmore and colleagues said, and a range of factors has been suggested to account for the bleeding, including prolonged labor and assisted delivery.
But for this study, the researchers studied 88 asymptomatic newborns, evenly divided between male and female, of whom 65 were delivered vaginally and the remainder by caesarian.
The babies were studied using a 3-Tesla MR machine, without anesthetic, between the ages of one and five weeks, the researchers said.
Analysis found that:
Seventeen of the babies -- or 26% of the cohort -- had bleeding, including 16 subdural, two subarachnoid, one intraventricular, and six parenchymal hemorrhages.
Seven infants had two or more types of bleeding.
None of the infants with bleeding had been delivered by C-section.
Intracranial bleeding was significantly associated with vaginal birth (at P<0.005) but not with prolonged duration of labor or with traumatic or assisted vaginal birth.
Typically, such small hemorrhages resolve over time without causing problems, the researchers said, although larger events may cause such issues as seizures, learning disabilities, or problems with motor development.
The author noted several limitations of the study which may have led to underestimates of the frequency of bleeding.
"The images were not obtained immediately after birth but in weeks one to five after birth, and, perhaps, we missed cases of intracerebral hemorrhage that had resolved. Also, our imaging protocol did not include T2*-weighted or magnetic susceptibility-weighted images, which might be even more sensitive for depiction of hemorrhage."
They also pointed out that "no follow-up images were obtained to determine imaging resolution of hemorrhage, and no clinical follow-up was performed after the identification of intracerebral hemorrhage."
"We just don't know at this time what these bleeds may mean over the long term," Dr. Gilmore said. "Ultimately, we hope to be able to determine whether intracerebral hemorrhage is associated with later neurodevelopmental problems." The group plans to follow this cohort longitudinally to see whether the perinatal bleeding is associated with future difficulties, such as idiopathic epilepsy.
The research was support by grants from the National Institute of Mental Health and the University of North Carolina School of Medicine. The researchers said they had no financial conflicts.
Normal Vaginal Births Cause Infant Brain Hemorrhages
正常产道生产可能导致婴儿脑出血
CHAPEL HILL, N.C., Jan. 30 -- Intracranial bleeding in newborns has been found common after a vaginal birth, although the bleeding is limited and apparently has no effect, according to researchers here.
北卡罗来纳大学Chapel Hill校园，1月30－－据研究人员称经产道生产的新生儿颅内出血是相当常见的，虽然出血量都较小目前看也没什么明显的影响。
Action Points
内容要点
Explain to expectant parents that this study has found small intracranial hemorrhages in about one in four infants delivered vaginally, compared with none among babies delivered by Caesarian section.
给期待中的双亲声明一下，该研究发现经产道出生的婴儿中四分之一合并小的颅内出血，与之相比，剖腹产无一例并发颅内出血。
Point out that the bleeding was limited and had no apparent short-term clinical effects.
指出：出血较少，短期内没有明显临床方面的影响。
Caution that more research is needed and note that the vast majority of people delivered vaginally appear to have no later difficulties.
In a study using magnetic resonance imaging, about one infant in four delivered vaginally had at least one form of intracranial hemorrhage, found John Gilmore, M.D., of the University of North Carolina School of Medicine, and colleagues.
建议多进行一些这方面研究来证实经产道出生的婴儿绝大部分日后确实没有不良后果。
美国北卡罗来纳州大学医学院John Gilmore博士和其同事研究发现，核磁共振成像显示四分之一产道出生的婴儿至少有一种形式的颅内出血。
MRI did not show signs of bleeding for babies born by caesarian delivery, they reported in the February issue of Radiology.
在《放射医学》2月份期刊报道说，MRI没有发现剖腹产婴儿有出血情况。
"Small bleeds in and around the brain are very common in infants who are born vaginally," Dr. Gilmore said. "It seems that a normal vaginal birth can cause these small bleeds."
Gilmore博士讲到，“产道出生的婴儿颅内出血相当常见，看来是正常产道生产造成的”。
But he added that although more research is needed on the implications of the hemorrhages, vaginal birth has not suddenly become unduly risky.
还说到虽然还有待更多研究出血的意义，但并不是说产道生产就非常不适合了。
"Obviously, the vast majority of us who were born vaginally and may have had these types of bleeds are doing just fine," he said. "Humans have been born vaginally for a very long time, and our brains probably evolved to handle vaginal birth without major difficulty."
他说：“很明显，绝大多数产道出生的包括有这种形式出血的婴儿都很好，产道生产已经有悠久的历史了，我们的大脑都没有什么大问题的”。
Intracranial hemorrhage in full-term infants is usually associated with symptoms such as apnea, bradycardia and seizures, Dr. Gilmore and colleagues said, and a range of factors has been suggested to account for the bleeding, including prolonged labor and assisted delivery.
Gilmore博士和其同事说到，足月儿颅内出血常合并呼吸暂停、心动过缓和癫痫发作等症状，与出血有关的一些因素包括产程延长和助产等。
But for this study, the researchers studied 88 asymptomatic newborns, evenly divided between male and female, of whom 65 were delivered vaginally and the remainder by caesarian.
该研究包括88例无症状的新生儿，男女各半，65例产道出生，13例剖腹产。
The babies were studied using a 3-Tesla MR machine, without anesthetic, between the ages of one and five weeks, the researchers said.
研究者称所有婴儿年龄在1－5周之间，采用3－T MR机器，不麻醉进行MRI检查。
Analysis found that:
分析发现：
Seventeen of the babies -- or 26% of the cohort -- had bleeding, including 16 subdural, two subarachnoid, one intraventricular, and six parenchymal hemorrhages.
Seven infants had two or more types of bleeding.
None of the infants with bleeding had been delivered by C-section.
Intracranial bleeding was significantly associated with vaginal birth (at P<0.005) but not with prolonged duration of labor or with traumatic or assisted vaginal birth.
17例－26％的产道出生婴儿－合并出血，包括16例硬膜下出血、2例蛛网膜下出血、1例脑室出血和6例脑实质内出血。
7例合并两种或以上形式的出血。
剖腹产婴儿无一例合并出血。
颅内出血和产道生产之间呈明显相关性(P<0.005)，但与产程增长、创伤以及助产均无相关性。
Typically, such small hemorrhages resolve over time without causing problems, the researchers said, although larger events may cause such issues as seizures, learning disabilities, or problems with motor development.
研究者们说，有意义的是这些小的出血最终会被吸收而不会引起任何问题，虽然有些稍多的出血可能会发生一些问题，如癫痫发作、学习能力缺失、运动发育。
The author noted several limitations of the study which may have led to underestimates of the frequency of bleeding.
作者指出了文章中的几点不足之处，由此可能会产生低估出血的发生率的结果。
"The images were not obtained immediately after birth but in weeks one to five after birth, and, perhaps, we missed cases of intracerebral hemorrhage that had resolved. Also, our imaging protocol did not include T2*-weighted or magnetic susceptibility-weighted images, which might be even more sensitive for depiction of hemorrhage."
“MRI成像全部是1－5周后才开始检查的，而非出生后即刻检查的，因此，那些检查之前出血已经吸收了的患儿可能就被漏检了。还有，成像方法没包括T2*-加权或核磁敏感加权成像，也就是说没有使用出血成像更敏感的方法检查”。
They also pointed out that "no follow-up images were obtained to determine imaging resolution of hemorrhage, and no clinical follow-up was performed after the identification of intracerebral hemorrhage."
还指出，没有跟踪报道成像从而观察出血吸收情况的成像，并且还缺乏颅内出血确诊之后的临床随访资料。
"We just don't know at this time what these bleeds may mean over the long term," Dr. Gilmore said. "Ultimately, we hope to be able to determine whether intracerebral hemorrhage is associated with later neurodevelopmental problems." The group plans to follow this cohort longitudinally to see whether the perinatal bleeding is associated with future difficulties, such as idiopathic epilepsy.
Gilmore博士说，“目前我们确实还不知道颅内出血长期的影响会怎么样，但我们最终目的是确定颅内出血会不会影响以后的神经发育问题”。该小组计划进行长期跟踪研究，确定围产期的出血是否与以后的种种问题如特发性癫痫等有关联。
The research was support by grants from the National Institute of Mental Health and the University of North Carolina School of Medicine. The researchers said they had no financial conflicts.
该研究由美国国立精神卫生研究所和北卡罗来纳州大学医学院赞助支持。研究者称他们没有利益冲突。
编译：标题：正常产道生产可能导致婴儿脑出血 字数统计1088
北卡罗来纳大学Chapel Hill医学院，1月30－－据研究人员称经产道生产的新生儿颅内出血是相当常见的，虽然出血量都较小目前看也没什么明显的影响。
内容要点：
给期待中的双亲声明一下，该研究发现经产道出生的婴儿中四分之一合并小的颅内出血，与之相比，剖腹产无一例并发颅内出血。并指出这些出血都较少，短期内没有明显临床方面的影响。建议多进行一些这方面研究来证实经产道出生的婴儿绝大部分日后确实不会有不良后果。
美国北卡罗来纳州大学医学院John Gilmore博士和其同事研究发现，并在《放射医学》2月份期刊报道，说核磁共振成像显示四分之一产道出生的婴儿至少有一种形式的颅内出血，但没有发现剖腹产婴儿有出血情况。Gilmore博士讲到，“产道出生的婴儿颅内出血相当常见，看来是正常产道生产造成的”。还说到虽然还有待更多研究出血的意义，但并不是说产道生产就非常不适合了。他说：“很明显，绝大多数产道出生的包括有这种形式出血的婴儿都很好，产道生产已经有悠久的历史了，我们的大脑都没有什么大问题的”。
Gilmore博士和其同事说到，足月儿颅内出血常合并呼吸暂停、心动过缓和癫痫发作等症状，与出血有关的一些因素包括产程延长和助产等。该研究包括88例无症状的新生儿，男女各半，65例产道出生，13例剖腹产。所有婴儿年龄在1－5周之间，采用3－T MR机器，不麻醉进行MRI检查。
分析发现：
17例－26％的产道出生婴儿－合并出血，包括16例硬膜下出血、2例蛛网膜下出血、1例脑室出血和6例脑实质内出血。7例合并两种或以上形式的出血。剖腹产婴儿无一例合并出血。颅内出血和产道生产之间呈明显相关性(P<0.005)，但与产程增长、创伤以及助产均无相关性。研究者们说，有意义的是这些小的出血最终会被吸收而不会引起任何问题，虽然有些稍多的出血可能会发生一些问题，如癫痫发作、学习能力缺失、运动发育。
作者指出了文章中的几点不足之处，“MRI成像全部是1－5周后才开始检查的，而非出生后即刻检查的，因此，那些检查之前出血已经吸收了的患儿可能就被漏检了。还有，成像方法没包括T2*-加权或核磁敏感加权成像，也就是说没有使用出血成像更敏感的方法检查”，由此可能产生低估出血的发生率的结果。还指出，没有跟踪报道成像从而观察出血吸收情况的成像，并且还缺乏颅内出血确诊之后的临床随访资料。
Gilmore博士说，“目前我们确实还不知道颅内出血长期的影响会怎么样，但我们最终目的是确定颅内出血会不会影响以后的神经发育问题”。该小组计划进行长期跟踪研究，确定围产期的出血是否与以后的种种问题如特发性癫痫等有关联。
该研究由美国国立精神卫生研究所和北卡罗来纳州大学医学院赞助支持。研究者称他们没有利益冲突。
